If you’re close to celebrating your 65th birthday, now’s the perfect time to learn how Medicare can support your ongoing health care. Whether still employed or enjoying retirement, California residents must recognize the ins and outs of Medicare to save money further along the road.
Of course, changes to health care coverage can be overwhelming, but that doesn’t mean you should put it off. The truth is, Medicare isn’t as complicated as it might seem, and with our experts by your side, we’ll find a plan to match your needs and budget. Read on as our experts explore Medicare Supplement Insurance and Medicare Advantage plans in California.
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California Medicare Insurance Trends
With almost 40 million residents, California is the most populous state in the U.S. California holds the most Medicare beneficiaries, too – 6,718,061! The Centers for Medicare & Medicaid Services (CMS) reported the following information on 2024 Medicare trends in California:
- 6,718,061 Californians are currently enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased from $16.64 in 2023 to $16.24 in 2024.
- There are 465 Medicare Advantage plans available in California in 2024.
- 100% of Californians with Medicare have access to Medicare Advantage plans.
- 100% of California residents have access to $0 premium plan options.
- There are 23 different Medicare prescription drug plans available to California residents in 2024.
- The lowest monthly prescription drug plan cost is $0.40.
Medicare Offered in California
Original Medicare (Part A and B) comes with out-of-pocket costs that the plan holder is responsible for. Medicare Supplement Insurance plans (Medigap) fill in these gaps, covering a portion of the expenses not included by Original Medicare, including deductibles, copayments, and coinsurance.
Some California Medicare Supplement Insurance plans offer additional benefits, such as emergency medical care outside the U.S.
Medicare Supplement plans in California only work with Original Medicare and are not compatible with Medicare Advantage. Supplement plans cannot provide coverage for prescription drugs or routine dental, vision, and hearing care; however, it is possible to purchase these services from insurers as add-ons.
Original Medicare
Californians have several options for Medicare, depending on their needs. If you choose original Medicare (Part A and Part B), you will be covered for the care you receive while at hospitals, hospices, and (some) skilled nursing facilities. Part B also covers care outside of a hospital for things such as:
- doctors’ visits
- screenings
- lab tests
- medical equipment
Medicare Advantage
Medicare Advantage plans in California include the same coverage as Original Medicare but may cover additional services, such as vision and dental services. This offers beneficiaries the convenience of having all benefits under a single plan.
Unlike Medigap plans, Medicare Advantage plans replace your Original Medicare coverage, and you’ll get the benefits through your Medicare Advantage plan instead of through the federally administered program.
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Medicare Supplement Plans
The birthday rule allows California Medicare beneficiaries to change Medicare Supplement Insurance (Medigap) plans around their birthday every year.
Californians can change their Medigap plan 30 days before their birthday and up to 30 days after their birthday – giving beneficiaries a 61-day window. The benefit of changing plans during this period is that you cannot be denied coverage or charged higher premiums based on health conditions.
Californians must already be enrolled in a Medigap plan to take advantage of the birthday rule and must not change to a higher-level plan with more coverage. For example, you cannot go from Plan B to Plan C, but you could move from Plan G to Plan N or stay on the same plan level.
Outside of the annual birthday open enrollment period, Californians can apply for a new Medigap policy at any time. However, doing so means insurers charge higher premiums or deny coverage based on medical conditions.
Companies offering Medigap plans in the state include:
- AARP – UnitedHealthcare
- Blue Cross of CA
- Cigna
- Continental
- Health Net
- State Farm
- USAA
(source)
California Medicare Enrollment
Californians are eligible for Medicare if they are a U.S. citizen and above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis. Use Medicare’s online eligibility tool if you are unsure if you qualify.
Requirements
- You are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 40 quarters.
- You are under age 65 and collect benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months.
- You have ESRD or ALS.
Enrollment Period Dates
Initial Enrollment Period
This is a seven-month window that allows you to sign up for a plan
- Begins 3 months before the month you turn 65
- Ends 3 months after the month you turn 65
Medicare Open Enrollment Period
This is when you can sign up for a plan, switch a plan or leave a plan
- Begins Starts October 15th
- Ends December 7th
Special Enrollment Period
Special enrollment periods allow you to enroll outside the regular enrollment periods under specific circumstances.
General Enrollment Period
This is when you can sign up for Medicare Part A and/or Part B if you didn’t sign up when first eligible or if you’re not qualified for a Special Enrollment Period.
- Starts January 1st
- Ends March 31st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 31st
California Enrollment Tips & Advice
Before enrolling in Medicare and Medicare Advantage in California, evaluate your options and weigh the pros and cons of price point, coverage, providers, and facilities in the plans’ networks, as well as ratings for Part C and Part D plans.
The California Department of Aging provides Medicare counseling through HICAP, a confidential and free service for anyone eligible or about to become eligible for Medicare. They offer guidance for Medicare enrollment and up-to-date information on Parts A, B, C, and D within California. Search for local HICAP services by county or call 1-800-434-0222.
You also have the option to speak to someone from the Medicare program directly at 800-MEDICARE (800-633-4227) or visit medicare.gov.
If you happen to have employer-sponsored coverage and need assistance, reach out to the California Department of Managed Health Care at 888-466-2219 or email [email protected].
How Do I Enroll in a Medicare Plan?
Californians are eligible for Medicare if they are a U.S. citizen and above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis.
If you have any questions about California Medicare and your eligibility for financial assistance, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you.
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